Nuss procedure: Technical modifications to ease bending of the support bar and lateral stabilizer placement

Background: Modifications defined to ease bending of the support bar and lateral stabilizer placement during minimal invasive repair of pectus excavatum (MIRPE) have not been reported. We herein report our experience with MIRPE including several technical modifications. Methods: A total of 87 patients who underwent MIRPE were evaluated retrospectively. Technical modifications are (1) a template drawn preoperatively according to the anthropometric measurements, (2) more laterally placed thoracal incisions, (3) single existing incision for multiple support bars, (4) to secure lateral stabilizers to support bar in inverted position. Results: The mean patient age was 11.2 ± 3.8 years. The mean operating time was 63.7 ± 18.7 min. The mean Haller index was 5.4 ± 2.1. Eight patients necessitated two support bars. The support bars were removed in 69 patients after the completion of treatment. Support bars were left in place 26.8 ± 4.3 months. Final chest contours of the 56 patients were evaluated as 12 months passed after support bar removal and excellent repair results were determined in 84.2%. Conclusion: Preoperative bending of the support bar according to anthropometric measurements and fixation of the lateral stabilizers to the support bar in inverted position facilitates bar shaping and lateral stabilizer placement

The safe limits of mechanical factors in the apnea testing for the diagnosis of brain death

Apneic oxygenation is an apnea testing method in the diagnosis of brain death. In this method, oxygen (O-2) is delivered into the trachea via an O-2 catheter (O2C). However, barotrauma may develop during O-2 insufflation into the trachea. Oxygen catheter diameters, O-2 catheter tip position in the trachea, and O-2 flow rate have been proposed as causes of barotrauma. This study was designed to highlight the airway pressure changes during apneic oxygenation in a model consisting of an anesthesia bag, which was connected to a pressure transducer and to an endotracheal tube (ETT). The pressure of the system was monitored while delivering O-2 continuously to the system through O2C of different diameters, which were placed in the ETT. Tested variables were ETT/O2C ratio, O2C tip position in ETT (proximal 1/3 of the ETT, mid point of the ETT, and distal 1/3 of the ETT) and O-2 flow rate (6, 8, and 10 L min(-1)). The increase in the airway pressure significantly correlated with O2C tip position in ETT (p = 0.017). ETT/O2C ratio smaller than 1.75 caused significantly high airway pressures (p < 0.05). The pressure was significantly higher at the flow rate of 10 L min(-1) O-2 compared with the flow rate of 6 L min(-1) O-2 (p < 0.01). Thus, ETT/O2C ratio, O2C tip position in ETT and O-2 flow rate are the important factors that determine the airway pressure in the trachea during O-2 insufflation. In conclusion, overlooked mechanical factors dangerously increase airway pressure during apnea testing

The Effect of Lidocaine on Injection Pain of Different Propofol Concentrations in Patients Receiving Remifentanil

Objective: The effectivity of remifentanil and lidocaine combination on the injection pain with 1% propofol was reported previously. However, this finding has not been investigated with different propofol concentrations. In this prospective, randomized, double-blind trial, we aimed to compare the effect of lidocaine on the injection pain of 1% or 2% propofol in patients receiving remifentanil. Material and Methods: One hundred patients undergoing ear-nose-throat surgery were randomly assigned into four groups (n= 25 each). Following 0.5 mu g/kg/min remifentanil, patients in Group 1 and Group 2 received 1 mg.kg(-1) 1% or 2% propofol the mixed with 2 mL of saline, respectively. Patients in Group 3 and Group 4 received 1 mg.kg(-1) 1% or 2% propofol mixed with 2 mL of 2% lidocaine after 0.5 mu g kg(-1) min(-1) remifentanil. Pain during the injection of propofol was assessed on a four-point scale (0= none, 1= mild, 2= moderate, 3= severe) Results: The incidence of none-mild pain on injection of 1% propofol was significantly lower in Group 1 (56%) compared to Group 3 (100%) (p= 0.00017). This finding was also seen between Group 2 (36%) and Group 4 (72%) (p= 0.010). However, the number of patients suffering from the injection pain was significantly greater in Group 4 compared to Group 3 (p= 0.004). Conclusion: Lidocaine 2% 2 mL mixed with propofol completely abolished moderate-severe pain induced by 1% propofol in patients who were given 0.5 mu g/kg/min remifentanil. However, some patients still suffered from injection pain caused by 2% propofol in spite of the combined effect of lidocaine and remifentanil

Comparison of Direct and Remote Ischaemic Preconditioning of Renal Ischaemia Reperfusion Injury in Rats

WOS: 000449525500009PubMed: 30505608Objective: One of the methods that can be used to prevent ischaemia reperfusion (IR) injury is ischaemic preconditioning. The aim of this study was to evaluate and compare the effects of remote and direct ischaemic preconditioning (RIPC and DIPC) histopathologically in the rat renal IR injury model. Methods: After obtaining an approval from the Dokuz Eylul University School of Medicine Ethics Committee, 28 Wistar Albino male rats were divided into four groups. In Group I (Sham, n=7), laparotomy and left renal pedicle dissection were performed, but nothing else was done. In Group II (IR, n=7), after 45 minutes of left renal pedicle occlusion, reperfusion lasting 4 hours was performed. In Group III (DIPC+IR, n=7), after four cycles of ischaemic preconditioning applied to the left kidney, renal IR was performed. In Group IV (RIPC+IR, n=7), after three cycles of ischaemic preconditioning applied to the left hind leg, renal IR was performed. All rats were sacrificed, and the left kidney was processed for conventional histopathology. Results: The histopathological injury score of the kidney was significantly lower in the sham group compared with the other groups (p<0.01). The injury scores of the DIPC+IR and RIPC+IR groups were significantly lower than in the IR group (p<0.05). In the RIPC+IR group, the injury score for erythrocyte extravasation was found to be significantly lower than in the DIPC+IR group (p<0.05). Conclusion: In the present study, it was demonstrated that both DIPC and RIPC decreased renal IR injury, but RIPC was found to be more effective than DIPC. This protective effect requiresfurther detailed experimental and clinical studies

Ischaemic preconditioning attenuates haemodynamic response and lipid peroxidation in lower-extremity surgery with unilateral pneumatic tourniquet application: A clinical pilot study

Introduction: The harmful effects of ischaemia-reperfusion on skeletal muscle during extremity surgery can be diminished by using medications or ischaemic preconditioning

Comparison of the Effects of the Remote and Direct Ischemic Preconditioning in the Liver Ischemia-Reperfusion Injury

Objective: Ischemia reperfusion (IR) injury can cause severe organ failures. Remote and direct ischemic preconditioning can be used to prevent ischemia-reperfusion injury. Present study compares the effects of remote and direct ischemic preconditioning in the rat model of hepatic ischemia-reperfusion injury. Material and Methods: Four groups, each including seven rats were included. In the sham group only laparotomy was performed. In the ischemia reperfusion group 25 minutes of total hepatic ischemia was induced followed by 120 minutes of reperfusion. The leg was subjected to three cycles of ischemic preconditioning (IP) before hepatic ischemia reperfusion in the remote IP + IR group. One cycle of hepatic ischemic preconditioning was performed before hepatic ischemia reperfusion in the direct IP+IR group. The length of the experiment was the same in all groups. At the end of the experiment blood and Liver samples were collected. Results: Levels of serum aspartate transaminase (AST) and alanine transaminase (ALT) were significantly lower in the sham group compared to other groups (p<0.001). Levels of serum AST and ALT in the remote IP + IR group were significantly lower than in the direct IP + IR (p<0.001, p<0.001, respectively) and IR groups (p<0.001, p=0.002, respectively). Hepatic tissue malondialdehid level and the histological score of liver injury were significantly lower than in the direct IP + IR group (p<0.001, p=0.002, respectively). Conclusion: Present study showed that when serum AST-ALT levels and hepatic histological score are considered, remote ischemic preconditioning protects the liver from ischemia reperfusion injury better than direct ischemic preconditioning. The effects and mechanisms of these two preconditioning methods must be compared in clinical and experimental studies

Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE)

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (&gt;30% decrease in blood pressure) or reduced oxygenation (SpO2 &lt;85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04-1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15-1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7-3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64-7.71) and mortality (RR=19.80; 95% CI, 5.87-66.7). Conclusions: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants